Book Review

? 8j*est in man because of his greater variety of response behaviour, due to the more complex structure and varied Action of his nervous system. Similarly the control exercised y mental processes, thoughts, feelings, volitions, etc., is an expression of the function of the highly complex and specialised rain and glandular organs of man. No scientific exposition 11 allow of a mystical freedom unrelated to cause and effect, t We can talk of a natural freedom related to definite causal

1927. Price 15s.?The present short treatise gives a y good account of these methods and enables the reader understand both the principles of treatment and the details ^ construction of the apparatus. Probably it is an exaggeration in that the lessened mortality of the gun-shot fractures the war was chiefly owing to the adoption of the Thomas P int.
It was the segregation of the cases under the care of the01 ??cers and the establishment of team work which was great secret of improvement of results. But now that the ue of Thomas's methods is generally recognised, it is of ? at value to have a small and clearly written book like the ite the technical directions necessary for their ?nicient application. Fatalism or Freedom : a Biologist's Answer. By C. Judson .?RICK-12mo. Pp. 106. London : Kegan Paul, Trench, ^rubner. 1927. Price 2s. 6d.?Are we free to control our u?t or is our behaviour rigidly predestined and beyond , r P?wer to alter ? This perennial problem is once more a ^C^ec^' this time from the standpoint of a biologist. The nor first considers biological control, and says : " Every he ]^nism t? some extent controls the environment in which i i ?s> an<i the pattern of this control of environment through naviour, is shaped by the internal organisation of the ividual which, in its turn, has grown up during the exercise these distinctly vital functions." This control is at its ? 8j*est in man because of his greater variety of response behaviour, due to the more complex structure and varied Action of his nervous system. Similarly the control exercised y mental processes, thoughts, feelings, volitions, etc., is an expression of the function of the highly complex and specialised rain and glandular organs of man. No scientific exposition 11 allow of a mystical freedom unrelated to cause and effect, t We can talk of a natural freedom related to definite causal ^?ies. This natural freedom means that a thing or process 11 specific organisation is able to exhibit the behaviour 59 characteristic of or typical for that organisation in an appropriate environment. This freedom must appear within the lawful system not opposed to it, its value depends on the pattern of the organisation, and the setting or total situation within which it operates. The powers of reflective thought and prevision are important factors in influencing the organisation within which the human being is free, yet his choice is none the less causally determined by the organisation of his reflexes, instincts and sentiments. We may, therefore, say that " the normal man in the normal environment is free to work out his own inner nature, and to enlarge and refine it." He has power to direct his bodily energies through different channels, and we may see that these choices are in accordance with natural law, though we may not be able at our present stage of knowledge to exactly state these laws. This concept of freedom must appeal to those who regard science as the method of approach to all the problems of life, and this little book may be confidently recommended to clarify a difficult subject.

It amply maintains the high level of Psyche
Miniatures on which the publishers are much to be congratulated. Part I. of this series will welcome Part II. They will remember that in the former the thesis was announced that all disease is one; as it were," There is no disease but Disease (and McDonagh is the exponent of Disease)." The changing aspect of disease from case to case was explained in terms of the essential humours ; it is true that in place of invoking phlegm or melancholy, one was told that the protein particles of the plasma were in a molecular dispersoid state, or that the viscosity of the serum was abnormal. The main theme of the present volume is chronic intestinal intoxication, the author's views on focal sepsis being frankly those of the " autotoxis " school of the nineties. If a patient has infected tonsils, or a dental granuloma, it is intestinal sepsis that has produced this. Three hundred pages are devoted to the discussion of this subject, with some one hundred and fifty elaborate case histories. In nearly all, treatment included colon lavage and the administration of substituted symmetrical urea compounds ; though since most had much other treatment, as operations, vaccines, dieting, contramine, thyroid, insulin, etc., the issue is somewhat obscured. It is distressing to read, ha 6-Ver^ kind of treatment, and in spite of the blood picture i Vln? been brought back to a normal condition, no clinical is ^r?Venient could be registered." The remainder of the book ev?ted to an explanation of the action of drugs, vaccines ba ' S?on a " rational " as opposed to an " empirical " ^ Sls> illustrated by means of the author's suggested electronic ftUilse for over a hundred preparations. These occupy much Jpce, some of them taking a whole page each ; but the average st ^1 rea<^er will be moved rather to awe than to under iKimg. An appendix on animal experiments and a 0 uminous index concludes the book ; but we are encouraged } the prospectus of Part III. to  to suicidal impulses ; may all be indicative of hardening of the colon. " The term Tonic Elastic Ration may be used for this non-plastic form of static as it manifests itself in the colon." On palpation, the ,n ls felt to harden up under the hand, and to be tender ; 8j f a very large proportion of the author's patients show this fen. Fortunately, diagnosis is comparatively easy, and treat-^ simple, consisting of intestinal antisepsis, antispasmodic gs, and avoidance of constipation. So that possibly many ysicians have been treating the condition for years on the symptomatology, without ever recognising the real cause of n ^ Patients' troubles. We are warned, however, that it does Ho v that because the patient has this complaint he has 0 other ; so that if failure attends our efforts to relieve we ust be prepared to look farther afield, to operative measures on e one hand, or to psycho-analysis on the other. Oxford University Press. 1927. Price 36s.? We review this book with much pleasure, for it is very creditable to the author, and is evidence of an immense amount of research into the literature and experience of the subject. He describes the normal, comparative and pathological anatomy of the tongue, and the appropriate treatment of its diseases, with abundant extracts of case-reports from numerous sources.
It is destined to become a standard work of reference.
The importance of cancer and its treatment necessitates a summary of his views.
We agree with his objection to preliminary ligation of the lingual arteries, and he argues reasonably against removing the glands before the tongue, intratracheal anaesthesia, and the preliminary administration of morphia except in very small doses. Of diathermy, he thinks it has few advantages, and serious disadvantages over the ordinary operation, although useful in less accessible situations. Many of the illustrations are excellent, but we think Figures 27, 46, 61, 65 and 106 could be improved in a future edition, for they fail to represent what is intended ; and the description of cancrum oris (page 135) might be revised. We commend the book very heartily, and congratulate the author on the way he has studied the copious literature.

Pneumothorax and Surgical Treatment of Pulmonary
Tuberculosis.

1927.
Price 10s. 6d. ?" No more hopeful ray of sunshine has ever come to illumine the dark kingdoms of disease than that introduced into the path of the consumptive through the discovery of artificial pneumothorax." Yet it is extraordinary to think of the profound ignorance of many tuberculosis officers with regard to this proven form of treatment. This book clearly sets out the indications and contra-indications. A full account is given of cases treated, and the surgical operations at present in use are discussed. Dr. Riviere is an enthusiast, he is strongly against too early interference, but thinks it a pity that the intermediate period is so often let pass, and that the method is far too often used as a last resort. In such cases the mortality is necessarily high. We feel that the author fails to lay sufficient stress on the importance of sanatorium regime as an adjuvant; and might give a more detailed explanation of the skiagrams. Point as regards the pathogeny of the rheumatic group the *S6ases?there is in the author's mind serious doubt as to be6 ln^ectiye element in its aetiology, " its pathogeny cannot pent up in the narrow compass of a septic tooth "?for him deffS-U^S ^rom a combination of factors, amongst which thyroid ciency is to the fore, hand in hand with local metabolic i]jS uybances. His discussions on the pitfalls of diagnosis are ig ^j^ting. The chapter on the prevention of rheumatism sh l sounc^ judgment and of recommendations which he of great benefit were they efficiently carried out. e , regards gout, diathesis or individual susceptibility to a , ^rnal influences is again the keynote?" in gout, as in nia, every man is a law unto himself." Altogether, a work r^enioting deep reflection, and inviting one to view the .^atic group from a standpoint rather different from that nich is customarv.
Diseases of the Lungs. By F. E. Tylecote, M.D., F.R.C.P* and G. Fletcher, M.D., M.R.C.P. Pp. viii., 270. London : Oxford University Press. 1927. Price 7s. 6d.?This is a comprehensive, well written little work, the authors showing throughout great practical knowledge of the subject. Their remarks on breath sounds and adventitious sounds are particularly happy and informative, and they indicate how the various types of breath sounds are really modifications of the sounds produced at the glottis, varying according to the conductivity of the lung tissues. These facts are usually not stressed enough in the ordinary text-books, the student thereby failing to understand the true significance of alterations in the respiratory murmur. A belated reference only is made to the treatment of bronchitis by vaccines, and not much faith is placed in this line of attack on bronchiectasis?under the aetiology of the latter condition, while it is claimed that one of the factors is an increased air pressure within the bronchi produced by coughing, it does not seem to be recognised that, given an intact thorax, there is a corresponding increase in pressure outside and around the bronchi.
The role of anaphylaxis in the aetiology of asthma does not seem to be elevated to the prominence which it deserves, and treatment with peptone injections does not appear to find great favour ; the antispasmodics and potassium iodide are the sheet anchors of general treatment. The diagnoses of empyemata and thoracic tumours are well discussed. The last chapter is devoted to pulmonary tuberculosis, the diagnosis of which is handled on sound common-sense principles, and the treatment and management of a case in a likewise commendable way. This book, presenting as it does certain facts in a way to make them the more easily appreciated, should certainly, as suggested in the preface, be most helpful and acceptable to the student and practitioner. Lewis & Co., Ltd. 1927. Price 3s. net.?Though rarely a source of serious alarm or trouble, the cumulative effect of chronic pain from varicose veins cripples the nation's workers considerably. This disability exists despite our present means of treatment.
In The Injection Treatment of Varicose Veins there seems a promise of great reductions in this silent suffering, borne largely by the weaker sex. Not that obliteration of varicose veins by chemical phlebitis is more effective than by operation, but its advantage is that life ^rea^ment does not interfere with the patient's ordinary cases^ au^^or says.
His opinion is based on 2,000 of V kuch experience, and the lucid and scientific handling ls subject, make the book a good guide to a new remedy. On this basis he states that medical psychology must confine itself to the description* classification and treatment of abnormal mental states. He deals first with hypnosis and hysteria, regarding them aS phenomena of dissociation, which is the basis of Janet's theory of the neuroses, but Dr. Mitchell properly criticises this aS giving no explanation as to why dissociation occurs in the particular way which we observe in any given patient. The explanation of this pathological process is to be found in the work of Freud, and most of the book is taken up in a revie^ of Freud's doctrine, with more particular reference to its most recent development. He discusses the development of the ego and the super ego from the id, the differentiation of the life and death instincts and the ultimate analysis of the eg?? as Freud deals with these problems. However, even Dr-Mitchell's customary lucidity does not make these theories very readily comprehensible ; and since Freud takes cognisance of other theories of instincts, or indeed of other teachers of psychology, comparison with his contemporaries is of no service whatever. It is claimed that these theories elucidate the behaviour of psychotic patients ; but, because Freud has, or thinks he has, formulated a complete explanation of the psychoneuroses, we may ask whether he is justified in applying the same explanation to the psychoses as if the problem was entirely the same. Finally, Dr. Mitchell refers to divergencies from the psvcho-analytic theory, and see in5 to regard them with scant respect. For those who wish t0 find a clear exposition of psycho-analytic doctrines presented in a relatively small compass, and in language as clear and simple as is comj>atible with scientific exactitude, the preset volume may be confidently recommended. j Wlsely concludes his remarks with a chapter devoted n^rpretation from the Negative."